Case Report: Fatal osimertinib-related interstitial lung disease during adjuvant therapy after left pneumonectomy in a patient with lung adenocarcinoma undergoing maintenance hemodialysis
Abstract
Osimertinib is recommended not only for advanced EGFR-mutated non-small cell lung cancer (NSCLC) but also as adjuvant therapy after complete resection, leading to increasing opportunities for its clinical use. However, interstitial lung disease (ILD) is a serious adverse event, and its incidence and severity have been reported to be higher in Japanese patients. We report a fatal case of osimertinib-related ILD that developed during adjuvant therapy in a patient undergoing maintenance hemodialysis after left pneumonectomy. A 71-year-old man was found to have a left upper lobe mass on chest computed tomography (CT) performed at the initiation of maintenance hemodialysis for nephrosclerosis. Transbronchial biopsy was nondiagnostic; however, lung cancer was strongly suspected clinically, and video-assisted thoracoscopic left pneumonectomy with mediastinal lymph node dissection was performed. Pathological examination revealed lung adenocarcinoma harboring an EGFR exon 19 deletion, pT2aN2bM0 (stage IIIB). Adjuvant osimertinib (80 mg/day) was initiated. Exertional dyspnea developed 37 days after treatment initiation, and chest CT on day 40 revealed peripheral ground-glass opacities in the remaining right lung. Osimertinib was discontinued, and empirical antibiotic therapy was initiated because both osimertinib-related ILD and infection were considered in the differential diagnosis. Shortly after admission, the patient developed rapidly progressive respiratory failure. Although…
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